不同方法选择可弯曲喉罩在中国成年男性患者鼻内镜手术中的应用  

Different formulae for flexible laryngeal mask airway size selection in endoscopic sinus surgery for China adult male

作　　者：崔旭[1] 王平[1] 陈红芽 潘楚雄[1] Cui Xu;Wang Ping;Chen Hongya;Pan Chuxiong(Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730

出　　处：《国际麻醉学与复苏杂志》2018年第6期545-549,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨以体重和身高为基础选择可弯曲喉罩（flexible laryngeal mask airway, FLMA）型号在中国成年男性患者鼻内镜手术（endoscopic sinus surgery, ESS）中的应用。方法100例拟行ESS的男性患者采用随机数字表法分为A组（以体重为基础选择FLMA型号，52例）和B组（以体重和身高为基础选择FLMA型号，48例）。两组均在快速诱导后置入FLMA，通过听诊、气道峰压和最大漏气压判断FLMA对位后行机械通气。主要观察指标是FLMA拟使用型号与实际使用型号的符合率，次要观察指标是一次置入FLMA的成功率、置入FLMA次数、纤维支气管镜（fiberoptic bronchoscopy, FOB）评分、喉体血染程度、术后咽痛评分。所有患者术前由同一名医师测量身高、体重、张口度、Mallampati分级，另一名医师（盲法）负责置入FLMA及之后的操作和记录。结果100例患者中95例（A组50例，B组45例）使用FLMA完成手术（4# 24例，5# 71例），其余5例（A组2例，B组3例）由于对位不理想改为气管内插管。A组拟使用4#/5# FLMA 23/27例，实际使用15/35例，符合率为72.0%；B组拟使用4#/5# FLMA 11/34例，实际使用9/36例，符合率为91.1%；两组比较差异有统计学意义（P〈0.05）。B组一次置入FLMA成功率为82.2%，与A组（56.0%）比较差异有统计学意义（P〈0.05）。两组气道峰压、最大漏气压、FOB评分、喉体血染程度、术后咽痛评分差异均无统计学意义（P〉0.05）。结论以体重和身高为基础的方法可以更准确地预测中国成年男性患者FLAM型号，提高置入成功率，更适用于ESS中FLMA的型号选择。ObjectiveThe objective of this study is to evaluate weight and height-based formulae for selecting the appropriate size of flexible laryngeal mask airway（FLMA） for China adult male in endoscopic sinus surgery（ESS）.MethodsOne hundred adult male patients （ASA class Ⅰ or Ⅱ, age≥18 years） were randomly allocated in group A （weight-based formulae： size 3 for weight〈50 kg, size 5 for weight≥70 kg, size 4 for the rest） and group B （weight and height-based formulae： size 3 for weight〈50 kg and height〈150 cm, size 5 for weight≥70 kg or height≥170 cm, and size 4 for the rest）. An experienced user inserted the FLMA after rapid induction. FLMA location was estimated by auscultation, ventilation peak pressure and oropharyngeal leak pressure. Intermittent positive pressure ventilation and total intravenous anesthesia were performed during operation. The primary outcome was concordant with FLMA size used according to the weight-based manufacturers＇ recommendations or the weight and height-based formulae. The secondary outcome was success rate of the first insertion, attempts of FLMA insertion, ventilation peak pressure, oropharyngeal leak pressure, fiberoptic bronchoscopy score（FOB）, FLMA inner contamination by blood and postoperative sore throat score. Measurements of height, weight, the size of the oral opening, Mallampati grades and random grouping were accomplished by the same anesthesia doctor. FLMA insertion and intraoperative and postoperative data collection were accomplished by another anesthesia doctor blindly.ResultsFLMA was used in 95 patients （50 in group A and 45 in group B） for ventilation during anesthesia. FLMA size 4 was used in 24 patients and size 5 in 71 patients. There were 5 cases （2 in group A and 3 in group B） switched to endotracheal intubation because of dissatisfaction with FLMA location. In group A, 23/27 cases were supposed to be used FLMA size 4/5, actually 15/35 cases were used FLMA size 4/5, the concordance in group A was 72.0%. In group B,

关 键 词：可弯曲喉罩 鼻内镜手术 成年男性 中国 

分 类 号：R614[医药卫生—麻醉学]